Portable chest radiography is a widely performed radiographic exam in the intensive care unit (ICU). Radiographs of patients in the ICU are captured for a number of reasons, including verification of the placement of life support tubing, line, wires, sensors, and related devices and as part of routine monitoring of a patient's condition.
Flat panel digital radiography (DR) systems are rapidly being introduced into the portable x-ray imaging environment. Advantageously, DR receivers directly convert radiation energy received into digital data, without the need for separate scanning or processing equipment. Because these devices generate image data directly, they are able to provide both a high-resolution image for diagnostic purposes and a lower-resolution preview image that can be used in the clinical environment and for quality control (QC) purposes, facilitating workflow for radiographic technologists in the ICU. Lower resolution images, for example, can be used to quickly provide sufficient information about the positioning of tubing and other life support devices needed in intensive care situations.
Currently, portable DR systems include a portable x-ray machine that generates x-ray radiation, a flat panel DR receiver or detector that is tethered by cable to the portable x-ray machine, a host computer for processing the captured image, and a monitor for assisting image QC. In general, however, existing portable x-ray systems are self contained, tending to be somewhat bulky and inflexible.
In a typical workflow for portable radiography, a technologist is provided with a hard-copy worklist that indicates imaging requirements for various patients in the ICU. The technologist captures the images of all patients on the worklist, then at some convenient opportunity (usually after completing the rounds), downloads the captured images to a PACS (Picture Archive Communications System) for subsequent clinical and diagnostic interpretation. Unfortunately, this conventional workflow pattern can sometimes be poorly suited to the requirements of patient care. The need to upload image data to the PACS or other archive system means that interpretation of the obtained images cannot be performed on-site, but requires coordination with off-site diagnosticians. Urgent care situations require personal intervention and are handled as exceptions rather than accommodated in the workflow. It can be difficult for the clinical staff to determine the status of a worklist request until some time after the image is obtained. There can be an undesirable delay in obtaining response information for problems of tube and line placement. Significant information that can help to guide the imaging process is not made available to the technologist unless it is provided in the worklist data. In addition, quality control (QC) suffers, since the technologist must wait for off-site processing and response in order to determine whether or not an obtained image is usable for diagnostic purposes.
There have been a number of attempts to improve the delivery of portable radiography services in the ICU environment and to provide bedside support for interpreting imaging results and improving patient care. For example, commonly assigned U.S. Pat. No. 7,573,034 entitled “MOBILE RADIOGRAPHY IMAGE RECORDING SYSTEM” to Heath et al. describes a portable radiography system with a network connection for providing an electronic worklist request, for helping to control various imaging functions, for accessing patient records, and for collecting information related to image capture. U.S. Pat. No. 7,016,467 entitled “MOBILE DIGITAL RADIOGRAPHY X-RAY APPARATUS AND SYSTEM” to Brooks describes a portable digital radiography system with a computer for control of the image capture process and for uploading image data from a DR detector to a networked Picture Archiving and Communications System (PACS) or other archive system.
While solutions such as these can help to improve the delivery and efficiency of mobile DR imaging for ICU and other environments, however, further improvements to workflow and more effective delivery of imaging services are still needed. With existing solutions, for example, the technologist does not have ready access to some types of information that can help to provide images that are more acceptable and useful to the diagnostician. This can include, for example, information on prior images obtained and on the imaging techniques used for earlier exams. Workflow remains cumbersome and assignment of technologist tasks still remains a largely manual process in many ICU environments. It can be difficult for the technologist to determine what is needed for each patient and to prioritize the sequence of images that are needed accordingly. There is still a tenuous link between useful information, such as technique settings used previously, and what is needed in order to obtain a new image for the same patient.
Overall, the need for improved support for bedside personnel has not been addressed by conventional solutions, so that considerable back-and-forth communications with off-site staff is often necessary in order to detect problems, such as tube positioning problems. Systems that perform such complex image analysis functions often require the full-resolution image and employ considerable computing power and are designed to show results on high-resolution displays that are used for diagnostic purposes rather than for quick clinical assessment. Conventional approaches have failed to take advantage of the full range of information about the patient and about patient images that can be made available to the imaging technologist and to the ICU staff.
Yet another shortcoming of mobile DR systems relates to lack of information to the technician on the clinical condition of the patient and diagnostic suitability of the image obtained. This type of information would be particularly helpful in the mobile DR environment, such as in ICU and other urgent care facilities, allowing the technician to know of problems as soon as possible and helping to provide input for corrective action.
Thus, while some advances have been made, there is a need for a portable digital x-ray imaging system that more effectively supports the requirements of ICU imaging and the needs of bedside clinical personnel.